Montana State University and local partners are on track to meet their goal of training 40 sexual assault nurse examiners in the first year of a new grant program aimed at increasing support for victims of sexual assault in Montana.
The three-year, $1.5 million grant was awarded in July 2024 to MSU’s Mark and Robyn Jones College of Nursing and the Montana Office of Rural Health and the Area Health Education Center by the federal Health Resources and Services Administration.
The work aims to increase the state’s number of sexual assault nurse examiners, or SANEs, who provide comprehensive physical exams to victims of sexual assault, outline pregnancy prevention resources, and connect victims to advocates, survivor services and other follow-up care. They can also collect physical evidence to aid in crime reporting and investigations.
Due to the sensitive nature of these patient interactions, it’s important that the nurses providing these services are well trained, said Sarah Wangerin, an instructor in the College of Nursing and training director for the grant.
“To know what information and what tests to collect, to know what to say to this patient, to know the standard of care they should be receiving — those are the kinds of things that SANE nurses are in a unique position to provide,” Wangerin said. “Even if hospitals want to offer these services, they’re expensive, and they’re not reimbursed enough to cover the cost.”
Over half of Montana’s counties lack trained SANEs, and many patients must travel over 250 miles for an exam, increasing the risk of lost evidence and delayed care. Access for pediatric care is even more limited, with only 13% of counties having a pediatric SANE, according to data collected by the College of Nursing .
Given its rural nature and lack of accessible health care for many populations, Montana is a key state to roll out this program, said Sydney Hunsaker, program coordinator for the Montana Office of Rural Health and Area Health Education Center at MSU.
According to federal data, Montana also has a state rape rate 10% higher than the national average, with Native American communities, women and people ages 10-19 experiencing disproportionate levels of sexual violence.
To become a SANE, registered nurses must complete 41 hours of training, 16 hours of clinical skills and pass a multi-hour exam. Through this program, Wangerin estimated it costs about $3,000 to train each SANE, factoring in stipends, tuition coverage and travel reimbursement costs.
So far, five trainings are scheduled for 2025, in locations from Billings to Lewistown to the Flathead Reservation. Two are specifically geared towards pediatric SANE curriculum.
Many of the nurses registered for training are “Bobcat nurses,” or MSU graduates, underscoring the connection of the grant program to the College of Nursing, Hunsaker said. In addition to the 46 nurses already registered for training this year, there are an additional 80 in the enrollment process, she added.
Hunsaker also shared data showing the importance of increasing the number of SANE-trained nurses. For example, in Kalispell, Logan Health reported in 2023 that its two SANE nurses were responsible for 88 forensic interviews, 50 pediatric consults, nine pediatric acute exams, 16 adult consults and 22 adult acute exams.
Due to that load, Hunsaker said SANE nurses often experience burnout. Coupled with often being the only SANE in a rural area, feelings of isolation are also common.
That’s why the College of Nursing is also building a statewide network where SANEs can connect with and support one another.  This network will offer regular group debriefing sessions with a trained therapist, educational webinars, and twice-yearly skill refresher courses to ensure nurses stay connected and supported in their roles.
Another key effort of the project is to establish a framework for sustainable training opportunities in the future, said Stacy Stellflug, the grant’s principal investigator and an MSU nursing professor.
“We’re thinking about how we continue and sustain this program going forward,” Stellflug said.
The goal is to establish a network of Montana SANE trainers and build a course that nurses could do online and on their own time, eliminating the obstacle of travel for training. That future course would be facilitated by the Montana Office of Rural Health and Area Health Education Center.
Other key collaborators on the work have been the Montana Health Network, the Montana Department of Justice’s Sexual Assault Response Network Committee and existing SANE nurses in Montana.
Learning from the existing nurses is key, with the goal of alleviating their burden of work by increasing access to SANEs throughout the state.
“We want to be mindful of their expertise and what they bring to the table,” Stellflug said. “But we also recognize that our state is huge, and they can’t be everywhere at the same time.”
Registered nurses who are interested in receiving SANE training can fill out this interest form or email sydney.pearce@montana.edu.
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